Left ventricular geometric patterns in end-stage kidney disease: Determinants and course over time

Menso J. Nubé, Tiny Hoekstra, Volkan Doganer, Michiel L. Bots, Peter J. Blankestijn, Marinus van den Dorpel, Otto Kamp, Piet M. ter Wee, Camiel L. M. de Roij van Zuijdewijn, Muriel P. C. Grooteman

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: While concentric left ventricular hypertrophy (cLVH) predominates in non–dialysis-dependent chronic kidney disease (CKD), eccentric left ventricular hypertrophy (eLVH) is most prevalent in dialysis-dependent CKD stage 5 (CKD5D). In these patients, the risk of sudden death is 5× higher than in individuals with cLVH. Currently, it is unknown which factors determine left ventricular (LV) geometry and how it changes over time in CKD5D. Methods: Data from participants of the CONvective TRAnsport Study who underwent serial transthoracic echocardiography were used. Based on left ventricular mass (LVM) and relative wall thickness (RWT), 4 types of left ventricular geometry were distinguished: normal, concentric remodeling, eLVH, and cLVH. Determinants of eLVH were assessed with logistic regression. Left ventricular geometry of patients who died and survived were compared. Long-term changes in RWT and LVM were evaluated with a linear mixed model. Findings: Three hundred twenty-two patients (63.1 ± 13.3 years) were included. At baseline, LVH was present in 71% (cLVH: 27%; eLVH: 44%). Prior cardiovascular disease (CVD) was positively associated with eLVH and ß-blocker use inversely. None of the putative volume parameters showed any relationship with eLVH. Although eLVH was most prevalent in non-survivors, the distribution of left ventricular geometry did not vary over time. Discussion: The finding that previous CVD was positively associated with eLVH may result from the permanent high cardiac output and the strong tendency for aortic valve calcification in this group of long-term hemodialysis patients, who suffer generally also from chronic anemia and various other metabolic derangements. No association was found between eLVH and parameters of fluid balance. The distribution of left ventricular geometry did not alter over time. The assumption that LV geometry worsens over time in susceptible individuals, who then suffer from a high risk of dying, may explain these findings.
LanguageEnglish
Pages359-368
JournalHemodialysis International
Volume22
Issue number3
DOIs
Publication statusPublished - 2018

Cite this

@article{7eabef114b7544e3b4e79381662c3a79,
title = "Left ventricular geometric patterns in end-stage kidney disease: Determinants and course over time",
abstract = "Introduction: While concentric left ventricular hypertrophy (cLVH) predominates in non–dialysis-dependent chronic kidney disease (CKD), eccentric left ventricular hypertrophy (eLVH) is most prevalent in dialysis-dependent CKD stage 5 (CKD5D). In these patients, the risk of sudden death is 5× higher than in individuals with cLVH. Currently, it is unknown which factors determine left ventricular (LV) geometry and how it changes over time in CKD5D. Methods: Data from participants of the CONvective TRAnsport Study who underwent serial transthoracic echocardiography were used. Based on left ventricular mass (LVM) and relative wall thickness (RWT), 4 types of left ventricular geometry were distinguished: normal, concentric remodeling, eLVH, and cLVH. Determinants of eLVH were assessed with logistic regression. Left ventricular geometry of patients who died and survived were compared. Long-term changes in RWT and LVM were evaluated with a linear mixed model. Findings: Three hundred twenty-two patients (63.1 ± 13.3 years) were included. At baseline, LVH was present in 71{\%} (cLVH: 27{\%}; eLVH: 44{\%}). Prior cardiovascular disease (CVD) was positively associated with eLVH and {\ss}-blocker use inversely. None of the putative volume parameters showed any relationship with eLVH. Although eLVH was most prevalent in non-survivors, the distribution of left ventricular geometry did not vary over time. Discussion: The finding that previous CVD was positively associated with eLVH may result from the permanent high cardiac output and the strong tendency for aortic valve calcification in this group of long-term hemodialysis patients, who suffer generally also from chronic anemia and various other metabolic derangements. No association was found between eLVH and parameters of fluid balance. The distribution of left ventricular geometry did not alter over time. The assumption that LV geometry worsens over time in susceptible individuals, who then suffer from a high risk of dying, may explain these findings.",
author = "Nub{\'e}, {Menso J.} and Tiny Hoekstra and Volkan Doganer and Bots, {Michiel L.} and Blankestijn, {Peter J.} and {van den Dorpel}, Marinus and Otto Kamp and {ter Wee}, {Piet M.} and {de Roij van Zuijdewijn}, {Camiel L. M.} and Grooteman, {Muriel P. C.}",
year = "2018",
doi = "10.1111/hdi.12644",
language = "English",
volume = "22",
pages = "359--368",
journal = "Hemodialysis International",
issn = "1492-7535",
publisher = "Wiley-Blackwell",
number = "3",

}

Left ventricular geometric patterns in end-stage kidney disease: Determinants and course over time. / Nubé, Menso J.; Hoekstra, Tiny; Doganer, Volkan; Bots, Michiel L.; Blankestijn, Peter J.; van den Dorpel, Marinus; Kamp, Otto; ter Wee, Piet M.; de Roij van Zuijdewijn, Camiel L. M.; Grooteman, Muriel P. C.

In: Hemodialysis International, Vol. 22, No. 3, 2018, p. 359-368.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Left ventricular geometric patterns in end-stage kidney disease: Determinants and course over time

AU - Nubé, Menso J.

AU - Hoekstra, Tiny

AU - Doganer, Volkan

AU - Bots, Michiel L.

AU - Blankestijn, Peter J.

AU - van den Dorpel, Marinus

AU - Kamp, Otto

AU - ter Wee, Piet M.

AU - de Roij van Zuijdewijn, Camiel L. M.

AU - Grooteman, Muriel P. C.

PY - 2018

Y1 - 2018

N2 - Introduction: While concentric left ventricular hypertrophy (cLVH) predominates in non–dialysis-dependent chronic kidney disease (CKD), eccentric left ventricular hypertrophy (eLVH) is most prevalent in dialysis-dependent CKD stage 5 (CKD5D). In these patients, the risk of sudden death is 5× higher than in individuals with cLVH. Currently, it is unknown which factors determine left ventricular (LV) geometry and how it changes over time in CKD5D. Methods: Data from participants of the CONvective TRAnsport Study who underwent serial transthoracic echocardiography were used. Based on left ventricular mass (LVM) and relative wall thickness (RWT), 4 types of left ventricular geometry were distinguished: normal, concentric remodeling, eLVH, and cLVH. Determinants of eLVH were assessed with logistic regression. Left ventricular geometry of patients who died and survived were compared. Long-term changes in RWT and LVM were evaluated with a linear mixed model. Findings: Three hundred twenty-two patients (63.1 ± 13.3 years) were included. At baseline, LVH was present in 71% (cLVH: 27%; eLVH: 44%). Prior cardiovascular disease (CVD) was positively associated with eLVH and ß-blocker use inversely. None of the putative volume parameters showed any relationship with eLVH. Although eLVH was most prevalent in non-survivors, the distribution of left ventricular geometry did not vary over time. Discussion: The finding that previous CVD was positively associated with eLVH may result from the permanent high cardiac output and the strong tendency for aortic valve calcification in this group of long-term hemodialysis patients, who suffer generally also from chronic anemia and various other metabolic derangements. No association was found between eLVH and parameters of fluid balance. The distribution of left ventricular geometry did not alter over time. The assumption that LV geometry worsens over time in susceptible individuals, who then suffer from a high risk of dying, may explain these findings.

AB - Introduction: While concentric left ventricular hypertrophy (cLVH) predominates in non–dialysis-dependent chronic kidney disease (CKD), eccentric left ventricular hypertrophy (eLVH) is most prevalent in dialysis-dependent CKD stage 5 (CKD5D). In these patients, the risk of sudden death is 5× higher than in individuals with cLVH. Currently, it is unknown which factors determine left ventricular (LV) geometry and how it changes over time in CKD5D. Methods: Data from participants of the CONvective TRAnsport Study who underwent serial transthoracic echocardiography were used. Based on left ventricular mass (LVM) and relative wall thickness (RWT), 4 types of left ventricular geometry were distinguished: normal, concentric remodeling, eLVH, and cLVH. Determinants of eLVH were assessed with logistic regression. Left ventricular geometry of patients who died and survived were compared. Long-term changes in RWT and LVM were evaluated with a linear mixed model. Findings: Three hundred twenty-two patients (63.1 ± 13.3 years) were included. At baseline, LVH was present in 71% (cLVH: 27%; eLVH: 44%). Prior cardiovascular disease (CVD) was positively associated with eLVH and ß-blocker use inversely. None of the putative volume parameters showed any relationship with eLVH. Although eLVH was most prevalent in non-survivors, the distribution of left ventricular geometry did not vary over time. Discussion: The finding that previous CVD was positively associated with eLVH may result from the permanent high cardiac output and the strong tendency for aortic valve calcification in this group of long-term hemodialysis patients, who suffer generally also from chronic anemia and various other metabolic derangements. No association was found between eLVH and parameters of fluid balance. The distribution of left ventricular geometry did not alter over time. The assumption that LV geometry worsens over time in susceptible individuals, who then suffer from a high risk of dying, may explain these findings.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85042193598&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/29461006

U2 - 10.1111/hdi.12644

DO - 10.1111/hdi.12644

M3 - Article

VL - 22

SP - 359

EP - 368

JO - Hemodialysis International

T2 - Hemodialysis International

JF - Hemodialysis International

SN - 1492-7535

IS - 3

ER -